JAC Advance Access originally published online on March 3, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 646-649
© 2004 The British Society for Antimicrobial Chemotherapy
Prospective, randomized study comparing quinupristin–dalfopristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections
Departments of 1 Infectious Diseases, Infection Control and Employee Health, 2 General Internal Medicine, and 3 Leukemia, The University of Texas M. D. Anderson Cancer Center, Texas, USA
Received 31 July 2003; returned 21 October 2003; revised 5 January 2004; accepted 15 January 2004
Objectives: Quinupristin–dalfopristin and linezolid have been shown to be efficacious in the treatment of vancomycin-resistant Enterococcus faecium (VREF) infections. However, the two antibiotics have not been compared in terms of safety and efficacy in a prospective randomized study. The objective of this study was to compare the safety and efficacy of the two drugs in the treatment of VREF infections in cancer patients.
Patients and methods: Forty cancer patients with VREF infection were randomized to receive linezolid 600 mg every 12 h or quinupristin–dalfopristin 7.5 mg/kg every 8 h. All patients were followed up for 30 days after discontinuation of study drugs.
Results: Linezolid and quinupristin–dalfopristin had comparable clinical responses (58% and 43%, respectively, P = 0.6). Myalgias and/or arthralgias occurred at a frequency of 33% in patients who received quinupristin–dalfopristin, but were not observed in the linezolid group (P = 0.03). In contrast, drug-related thrombocytopenia occurred in 11% of patients who received linezolid, but was not observed in the quinupristin–dalfopristin group (P = 0.2).
Conclusion: In cancer patients, quinupristin–dalfopristin treatment is associated with a relatively high frequency of myalgias/arthralgias; however, profound thrombocytopenia might limit the choice of linezolid in a subpopulation of cancer patients.
Keywords: enterococcal infections, enterococcal bacteraemia, resistant Gram-positive infections, Synercid, Zyvox
* Correspondence address. Department of Infectious Diseases, Infection Control and Employee Health (Unit 402), The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, USA. Tel: +1-713-792-7943; Fax: +1-713-792-8233; E-mail: iraad{at}mdanderson.org
Present address. University of Balamand Faculty of Medicine & Medical Sciences, Beirut, Lebanon
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